State Consumer Disputes Redressal Commission
Chhaya Wd/O. Mithu Wagh vs 1. Reliance General Insurance Company on 7 December, 2012
1 F.A.No.: 594-11
MAHARASHTRA STATE CONSUMER DISPUTE REDRESSAL
COMMISSION, MUMBAI, CIRCUIT BENCH AT AURANGABAD
Date of filing : 09.11.2011
Date of Order: 07.12.2012
FIRST APPEAL NO.: 594 OF 2011
IN COMPLAINT CASE NO.: 704 OF 2010
DISTRICT CONSUMER FORUM: AURANGABAD.
Chhaya wd/o. Mithu Wagh
R/o. At. Adhul Post-Adhul Tq. Paithan,
Dist. Aurangabad. ...Appellant
-Versus-
1. Reliance General Insurance Company
Through its Manager,
Office at, 570 Rectifier,
House Nandigram Cross Road,
Near Industrial Estate, Wadala,
Mumbai.
2. Kabal Insurance Services Pvt. Ltd.,
Through its authorize signatory
Plot No.7, E-Sector, Varsha Hotel,
CIDCO Cannaught,
Aurangabad-431 003.
...Respondents
... Respondent
3. Agricultural Officer,
At: Paithan, Tq. Paithan,
Dist. Aurangabad.
Coram : Mr. B. A. Shaikh, Hon'ble Presiding Judicial Member
Mr. K. B. Gawali, Hon'ble Member Present: Adv. Shri. A. M. Mamidwar for appellant.
Adv. Shri. R. H. Dahatg for Respondetn No.1.
None for Respondent No. 2 & 3.
- :: ORAL ORDER ::-
Per Mr. B. A. Shaikh, Hon'ble Presiding Judicial Member 2 F.A.No.: 594-11
1. This appeal is directed against the judgment and order dated 27.09.2011 passed in C.C. No. 704/2010 by the District Forum, Aurangabad, whereby the complaint has been dismissed. The said complaint was filed with the allegations in brief that the complainant's husband Mithu Wagh was the agriculturist and he died due to lightening on 05.07.2009. The risk of the life of Mithu Wagh was covered under "Farmers Group/Personal Accident Insurance Policy" issued by the respondent No.1/opponent No.1. Therefore the complainant submitted claim proposal along with requisite documents to the respondent. The respondent No.1/opponent No.1 kept pending her proposal without any reason. Therefore she prayed the direction be given to the respondents to pay her insured amount of Rs.1,00,000/- with compensation of Rs. 10,000/- towards harassment and cost of Rs.10,000/-.
2. The respondent No.1 Insurance Company filed the written version and denied the allegations made against it. It submitted that the claim proposal was not submitted within stipulated period of 90 days after expiry of the period of policy. Hence it repudiated the claim vide letter dated 24.11.2010. It also submitted that the mutation abstract produced by the complainant was suspicious and 7/12 extract was not produced by her. It therefore submitted that complaint may be dismissed.
3. The District Forum dismissed the complaint on the ground that the mutation abstract dated 28.06.2009 produced by the complainant shows over writing on its date of sanction as initially the date of sanction was written as 11.09.2009 and by over writing, it is mentioned as 28.06.2009, and therefore it is suspicious document. No evidence of sanctioning authority is adduced by the complainant and the partition deed on the basis of which mutation was recorded was also not produced. Therefore it dismissed the complaint.
4. It is submitted by the advocate of the appellant/org.complainant that, the District Forum below has not properly considered the evidence adduced by the complainant. He also submitted that the document of mutation abstract is very 3 F.A.No.: 594-11 clear and that the claim was not repudiated on any such ground mentioned in the impugned judgment and order. He further submitted that the repudiation on the ground of late submission of proposal can not be sustained under law as there was no mandatory term and condition for filing the claim proposal within a period of 90 days as stated in the letter of repudiation. He relied upon the observation made by the Hon'ble National Commission in the group of Revision Petitions Nos. 3118 to 3144 of 2010 in cases of Laxmibai & Co. Vs. ICICI Lombard General Insurance Co. Ltd and Ors, decided on 05.08l.2011. In that case it is observed that Cases where claim is made to nodal officer or nodal officer has forwarded the claim to Insurance Company or claim has been directly filed with Insurance Company within 2 years of the death and the claim has remained undecided, in such a case the cause of action will continue till the day of Respondent/Insurance Company pays or rejects the claim.
It is therefore submitted by the advocate of the appellant that the impugned judgment and order may be set aside and relief sought for in the complaint may be granted.
5. On the other hand, the advocate of the respondent No.1 supported the impugned judgment and order. He also submitted that the District Forum can not go beyond guidelines laid down by the Government of Maharashtra for submission of claim proposal under the "Farmers Personal Accident Insurance Policy". According to him as per said guidelines the claim proposal is required to be filed within 90 days from the last date of the period of policy and as the said claim was not filed within that period the repudiation of the claim is proper.
6. It is worthy to note that the claim was not repudiated on the ground of any such suspicious documents submitted by the complainant/appellant as discussed in the impugned judgment and order. It is not disputed that the deceased Mithu Wagh was husband of the complainant and he accidentally died on 05.06.2009 due to lightening. She forwarded claim proposal to the Respondent No.1 through the Respondent No.2, along with the requisite documents. The 4 F.A.No.: 594-11 mutation abstract No. 2583 shows that there is some over writing on the date of sanction. As per that mutation entry, the claim of Mithu Wagh was recorded as owner of the agricultural land on the basis of partition deed. The said mutation entry was sanctioned on 28.06.2009 and correction made by over writing is also attested by the sanctioning authority. The said mutation abstract can not be doubted only on the basis of the said over writing which is duly attested, particularly when the claim was not repudiated on any such ground of suspicious document. Therefore we find that the order about dismissal of the complaint on the ground of suspicious nature of the document can not be sustained under law.
So far as the repudiation of the claim on the ground of submission of claim proposal after 90 days from the date of validity of the insurance policy is concerned, it is seen that no such policy was produced showing the term and condition showing time limit for filing the claim proposal in consequence of the death of a farmer. No doubt the Government of Maharashtra under G.R. dated 07.07.2006 stated that, the claim proposal under the aforesaid scheme will be accepted within 90 days of the last date of the policy.
In support of submission that as the claim was not forwarded within 90 days, it can not be entertained, respondents advocate relied upon following cases.
i) The New India Assurance Co. Ltd, Vs. Chandrakant Motichand Kandle, reported in 2008 (3) CPR 116.
In that case there was a term in the policy that the complaint declaimed the liability and such claim was not within 12 months from the date of such disclaimer then the claim shall be deemed to have been abandoned.
In that case it is held that complaint was not maintainable as it was not filed within 12 calendar months from the date of repudiation.
ii) Sasanka Mohpatra Vs. Chairman-cum-Managing Director, New India Assurance Company Ltd., reported in 2008 (2) CPR 132 (NC) 5 F.A.No.: 594-11 In that case the claim was lodged by father of the complainant after complainant had met with an accident and suffered from disability. The repudiation was upheld by the Hon'ble State Commission as well as the Hon'ble National Commission.
8. In the instant case, no policy is produced showing the mandatory term that if claim proposal is not submitted within 90 days of the end of the period of policy then claim would be deemed as abandoned. The directives of Government of Maharashtra as given in aforesaid G.R. dated 07.07.2006 simply shows that, claim would be entertained within 90 days of the last date of period of policy. It does not specify a condition that if claim is submitted after 90 days of the last date of the period of policy then, the claimant would not be entitled to any compensation under that policy. The aforesaid case law's relied upon by the advocate of the respondent No.1 are not applicable to the facts and circumstances of the present case, as they are totally different from those of present case.
9. In the complaint it is stated that, the complainant sent the proposal with the concerned authority on 06.11.2009. As per the case of the respondents, the said claim was submitted on 24.12.2009 and it ought to have been filed on or before 14.11.2009. Thus, as per opponent there is delay of one month and ten days in submitting the claim proposal. In our view, when no policy is produced showing that the complainant has committed breach of any such condition so as to disentitle her from claiming compensation under the said policy. Therefore we hold that the repudiation of the claim by the opponent No.1 can not be sustained under law. The District Forum below has not considered these material facts and erroneously dismissed the complaint.
10. We thus held that, the complainant is entitled to compensation of Rs.1,00,000/- under the "Farmers Personal Accident Insurance Policy" form the respondent No.1 Insurance Company. Moreover, complainant is also entitled to interest @ 9 % p.a. from the date of complaint over the said amount till its realization. She is also entitled to compensation Rs.2000/- towards mental 6 F.A.No.: 594-11 harassment, as well as Rs.1000/- towards cost of the complaint from the respondent No.1. Hence following order is passed.
O R D E R
1. The appeal is allowed as under:
2. The impugned judgment and order passed by the District Forum below in C.C. No.704/2010 on 27.09.2011 is hereby set aside. The said complaint is granted as under:
3. The opponent No.1 Reliance General Insurance is directed to pay to the complainant compensation of Rs. 1,00,000/- with the interest @ 9% p.a. from the date of the said complaint i.e. from 04.12.2010 till its realization.
4. The respondent No.1 shall also pay to the complainant Rs.2000/- towards mental harassment and Rs.1000/- towards cost of the complaint within a period of one month from receiving the copy of the present judgment and order.
5. Copies of the judgment and order be sent to both the parties.
(K. B. Gawali) (B. A. Shaikh)
Member Presiding Judicial Member
Kalyankar